Liberal’s Approach to Health Care Reform Made Abortion Controversy Inevitable

Democrats paid a heavy toll to keep health care reform moving forward. They were forced to accept substantial and virtually unprecedented limits on abortion coverage in order to get the Affordable Health Care for America Act through the House of Representatives. This result should awaken them to the need to rethink their approach, but it assumes they learned the key lesson: where government goes, ideology follows.

Speaker Nancy Pelosi needed 218 votes to make history: passage by the House of the Affordable Health Care for America Act. Liberals got her most of the way there, but to get across the finish line Speaker Pelosi needed support from moderates and conservatives. This meant cutting a deal with the pro-life caucus. The result: HR 3962 prohibits the government-run medical plan and coverage offered through the health insurance exchanges the bill would create from covering elective abortion procedures. Liberals are furious, but to pass health care reform they had to accept this restriction as part of the package.

This post is not about the politics or morality of abortions. Readers of this blog are on both sides of this issue. This blog is about health care reform and what happened to HR 3962 concerning abortion highlights one of the greatest pitfalls in Democrats approach to reform. If they continue down the road they are on, increasing the amount of America’s health care system government directly controls and manages, the party is guaranteeing that similar defeats on similar public policy issues is all but a certainty. The issue today is abortion. In the future it could be access to birth control. Or making coverage available to domestic partners. The fact is, government-run health care does not and cannot exist in a vacuum. Politics and ideology inevitably come along for the ride.

The final health care reform bill may loosen the prohibition on abortion coverage contained in the House bill. But if the restrictions are diminished, it will be because Democrats led by Speaker Pelosi and Senate Majority Leader Harry Reid are in control of Congress and President Barack Obama occupies the Oval Office.

For now.

Eventually conservatives will be in power again. No party or ideology dominates America’s politics forever. And a conservative government will not hesitate to use the tools given to it by Democrats to push forward their agenda merely because those tools were created by liberals. 

No one should be surprised about this political reality. In a post back in August 2007 I warned single payer advocates that a government takeover of health insurance would open the door to ideology meddling by conservatives. And in August of this year I reminded liberals that while Democrats are ascendant today, politics, like a pendulum, eventually changes direction. “In 2001 the President was George W. Bush, the Senate Majority Leader was Trent Lott and the House Speaker was Dennis Hastert (just two years earlier it had been Newt Gingrich). Their view of how a public health plan should work – what it covers and who it benefits – varies considerably from the Obama/Reid/Pelosi view. Yet the greater the role liberals give the government over health care, the more control over issues like abortion conservatives like Bush/Lott/Hastert will have when they take power again – and eventually, they will.”  And I’m hardly the only observer to state this reality.

So Democrats face a critical choice. They can pursue their health care reform goals care by increasing government’s direct participation in the market or by looking to the regulations the government imposes on the market.  One opens the door wide to groups of lawmakers holding health care reform hostage to unrelated public policy issues; the other narrows this opening.

For example, lawmakers want to prohibit carriers from denying consumers coverage because of their current or previous health conditions. Creating a health insurance exchange is one method of achieving this goal, but it is not the only way. And alternatives limit the opportunity for ideological meddling in Americans’ lives.

Yes, a public plan would increase competition in the market (a primary justification for a government-run plan), but so would health insurance co-operatives. And as non-government entities, co-operatives would be less susceptible to partisan interference.

By focusing on their goals and being careful of their methodology for achieving them, Democrats can have their health care reform and limit the price they’ll pay on other issues. Or they can continue down a road in which accepting limits on abortion coverage is merely the first of many heavy and painful tolls they will pay.

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Health Care Reform: Fear and Loathing

Health care is personal, important, confusing and expensive. No wonder so many people are upset at attempts to reform America’s health care system. The status quo may be broken, but the devil known is more welcome than the devil coming to town.

It’s especially scary for conservatives who look at the folks doing the reforming and are terrified. When they see President Barack Obama, Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi they see liberals – actually they see LIBERALS. The kind their parents warned about. These aren’t fellow Americans with whom they happen to disagree, they’re “the others,” the socialists, the government building, boogie men of talk radio and a certain 24 hour news station. (And yes, this being America, there’s a 24 hour news station boosting fear of conservative boogie men, too).

It takes a giant leap to think that elected leaders in America are plotting to create a system with death panels that will impose euthanasia on seniors, make virtually every health care decision in the country, murder millions of children and much more. Yet those are the accusations made by former Governor Sarah Palin, Cal Thomas, Representative Virginia Foxx, and Representative John Shadegg. And many on the right take are predisposed to take these accusations seriously.

Then there are more legitimate controversies that health care reform impacts. For example, should health plans health plans be required to cover abortions? That’s a legitimate public policy issue although it’s often weighed down by political rhetoric that obscures the real issues.

All of this makes it easy for liberals to dismiss these concerns. They see the need for a public health insurance plan to increase competition, not drive private carriers out of business. Evaluating the cost and effectiveness of care makes common sense and sound economics. It has nothing to do with being intrusive. There’s nothing sinister about this approach, but conservatives view such claims with fear and loathing.

What we have here are two groups of people looking into the same room from different windows. What they see is colored by where they stand and the prejudices they bring to the view. Where one sees conspiracy and death panels the other sees common sense and prudent regulation.

This is more than just a fascinating glimpse into the human psyche and how it plays out in the public policy arena. It underscores the challenge facing those seeking change. They need to not just fashion a workable system, but they have to deal with the fears and suspicions of those who instinctively oppose them – fears and suspicions that are stoked for self-aggrandizement and profit by the Glenn Becks and Michael Moores of the world.

Then there’s the political element of this dynamic. Liberals can comfortably ignore the concerns of conservatives regarding health care reform. All they need to do is bring enough moderates along to build the majorities needed to pass their legislation.

But in American politics the pendulum swings. In 2001 the President was George W. Bush, the Senate Majority Leader was Trent Lott and the House Speaker was Dennis Hastert (just two years earlier it had been Newt Gingrich). Their view of how a public health plan should work – what it covers and who it benefits – varies considerably from the Obama/Reid/Pelosi view. Yet the greater the role liberals give the government over health care, the more control over issues like abortion conservatives like Bush/Lott/Hastert will have when they take power again – and eventually, they will.

Fear and suspicion, anger and foolishness knows no ideology. The left and right are equally susceptible to assuming and perceiving the worst in the actions and words of the other side. Both have paid cheerleaders to make stoke their worst predilections.

As lawmakers consider the impact of health care reform they should keep in mind the American political wheel turns. Eventually all of us watch our elected leaders with fear and loathing. And the greater the influence government has on health care the more vitriolic the suspicion, anger – and the danger.

Obama’s First Health Care Reform Test: His Tax Increase Proposal

Health care reform rarely is accomplished in a process that is anything like a straight line. In 2009, for example, changing America’s health care system first requires addressing the nation’s tax system. That may not be intuitive, but it does seem to be the way things are working out.

President Barack Obama makes very clear that comprehensive health care reform is an integral part of his economic recovery program. Impressively, he has already accomplished a number of his goals, specifically inclusion of funding for health care technology as part of the recently passed stimulus package and the renewal and expansion of the State Children’s Health Insurance Plan (SCHIP). Those were just the start of his reform efforts, however. And now comes the difficult part.

President Obama wants to change the way Americans purchase and use their health care. He wants to achieve near universal coverage, reduce the cost of both health insurance and of medical care, and vastly reduce wasted spending on health care. This is not an easy task — just ask California Governor Arnold Schwarzenegger. Or Secretary of State Hillary Clinton, for that matter.

President Obama’s mission is complicated by the withdrawal of former Senator Tom Daschle to lead the Administration’s health care reform efforts. Senator Daschle had tremendous credibility in Congress and policy wonks alike. He was a superb choice to serve as President Obama’s Secretary of Health and Human Services and to be Director of the White House Office of Health Reform.  His nomination withdrawn due to Senator Daschle’s tax problems, the Administration is unlikely to find a replacement of equal political heft, access to the President and in-depth knowledge of the issue.

Finding a leader for is the Administration’s second most pressing health care reform challenge. The first is passing a tax increase. Here’s how it plays out.

The stimulus plan supported by President Obama greatly increases the nation’s spending. At the same time, the Obama Administration inherited a budget deficit of about $1.3 billion courtesy of the Bush Administration. This week, in a White House summit on fiscal policy and in an address to Congress, President Obama will make clear his commitment to slashing the deficit to $533 billion by 2013. To do that, according to the Associated Press, he will: 1) reduce spending on the Ira war; 2) end “temporary” tax breaks enacted during the administration of President George W. Bush on those making $250,000 or more a year; and 3) increase government efficiency. Among those programs slated for streamlining is reducing Medicare Advantage subsidies to insurance companies according to the New York Times.

The Administration is also likely to propose treating investment income earned by hedge-fund and private-equity partners as ordinary income according to the Bloomberg Press. This income is currently taxed at the capital-gains rate of 15 percent. Ordinary income is taxed at as much as 35 percent (but could go up to 39.5 percent if the Bush tax cut for those earning $250,000 or more is repealed.

Without these savings, President Obama will be hard pressed to finance expansio of health care reform and his energy  initiatives, increase education spending and enact his homeowners assistance program and send more troops to Afghanistan and reduce the deficit.

Of these, make no mistake: health care reform is near or at the top of the list.  As Office of Management and Budget Director Peter Orszag puts it, as quoted in the New York Times, “He wants to present an honest budget, he wants to focus on health care ….”  The Times quotes senior adviser David Axelrod as explaining, “The president believes there are essentially three areas that have to move forward even as we pare back elsewhere — health care, energy and education.”

It all comes down to the economy, however. And most objective observers would agree that America needs health care reform to have a sound economy. (The debate is not over whether reform is needed, it’s what kind of reform is required). So health care, taxes and the rest are all tied up in the Administration’s effort to right America’s fiscal ship.

We’ll have updated estimates as to how much revenue the tax increases are expected raise over the next four years when President Obama introduces a summary of his budget later this week. Clearly, however, it will be a critical component to the Administration’s fiscal goals. If the tax increases fail, it will be substantially harder for President Obama to finance a big ticket item such as his health care reform proposal. With the increases, he will have demonstrated his political acumen and bolstered his bargaining position with Congress while, at the same time, finding the revenues he needs to implement his plans.

So the first test of whether President Obama can pass his health care reform will not be a vote on creating a Federal Health Board or establishing a national purchasing exchange. It won’t mention guarantee issue or community rating nor even provider reimbursement levels. It will be a vote on whether a tax reduction scheduled to expire in 2011 will be allowed to so, then or sooner. Not a straight line, but a necessary course of action nonetheless.

Coming Soon: A Down Payment on Health Care Reform

The battle over the State Children’s Health Insurance Plan (SCHIP) was one of the most emotional battles of between Congress and the White House during the Bush Administration’s waining years. Twice, bi-partisan majorities of Congress passed the reauthorization legislation. Twice President George Bush vetoed the bill. Although the votes for an override were available in the Senate, it narrowly lost in the House. That’s now about to change. Congress is working hard to have a reauthorization of the State Children’s Health Insurance Plan (SCHIP) ready for the new president’s signature as soon as possible — it will be tough, but possibly even on inauguration day.

SCHIP provides health insurance for children in households that earn too much to qualify for Medicaid, but are unable to afford private coverage. States administer the program and, within federal guidelines, may adjust eligibility. They also pay a significant portion of the program’s cost. Currently, about six million children are covered in the popular program.

Congress twice voted to expand the SCHIP program in late 2007, but could not muster enough votes in the House of Representatives to overcome President George Bush’s vetoes. That was then. Now Democrats have stronger majoirites in both the House and Senate. Even more significantly, President-elect Barack Obama is a supporter of the expansion.

According to the Associated Press, discussions on how to approach the SCHIP reauthorization have been underway in Washington.  Although there was some thought of including SCHIP expansion in the forthcoming economic stimulus package, the decision seems to have been made to move forward with the stand-alone bill. While not promising to have the legislation ready for signature on inauguration day, House Speaker Nancy Pelosi promised “we’ll be done soon,” according to AP.

The first test for the SCHIP reauthorization will be in the House Energy and Commerce Committee. The Committee’s chair, Congressman Henry Waxman, called passing the legislation a “down payment on national health insurance.”

Passage of the SCHIP reauthorization would be more than a symbolic breaking with the past. The current recession is placing greater demands on safety net programs like SCHIP. In addition, states pay a significant portion of the coverage provided by SCHIP (from  17 percent to 35 percent depending on the state). Knowing where the program stands — and how much funding they can expect — is of critical importance to state lawmakers struggling with their own hemorrhaging budgets.

How Congress will pay for expanding the program still needs to be worked out. In 2007 the legislation included a 61-cent per pack tax on cigarettes. This was expected to allow the program to insure as many as 10 million children.

SCHIP is a critical component of the patchwork quilt that is America’s health care system. A majority of both Democrats and Republicans agreed it should have happened over a year ago. That it took a new Congress and a new President to get the job done demonstrates how hard achieving comprehensive and meaningful health care reform will be. But to use Congressman Waxman’s terminology, it’s a down payment well worth making.